Tertiary prevention interventions for patients with stroke in African countries : a systematic review

Objectives To summarise the best available evidence on tertiary prevention interventions for patients with stroke conducted in African countries, identify the gaps in stroke prevention research and augment efforts to establish stroke rehabilitation guidelines in African countries. Design We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement on the basis of a published protocol. Data sources We conducted a systematic search of nine electronic databases, including PubMed, the Cochrane Library and African Index Medicus, published until August 2023 and additionally contacted authors and screened reference lists. Eligibility criteria We included randomised controlled trials (RCTs) and prospective cohort studies on African adult patients with a clinical diagnosis of stroke. The primary outcome was global disability, and secondary outcomes were neurologic function scales. Data extraction and synthesis Two authors independently screened the search results, with data extracted by one author and verified by a second author. The data were narratively synthesised. A meta-analysis was done using a random-effects model for metric data using standardised mean differences. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results Of 3305 publications, 25 studies met the inclusion criteria involving cumulatively 973 patients with subacute and chronic stroke. Two-thirds of the trials were conducted in Nigeria and Egypt. The interventions covered physiotherapeutic, electrophysiologic, psychotherapeutic and transitional care domains with mostly beneficial outcomes. All included studies were RCTs with some concerns about methodologic quality. Conclusion This systematic review comprises heterogeneous effective interventions for tertiary stroke prevention mostly conducted in small productive research clusters. There is a growing body of research from African countries covering important fields of stroke rehabilitation, including local adaptations of the rehabilitation process and new knowledge concerning transcranial magnetic stimulation. There remains an urgent need to implement interventions aimed at overcoming barriers to stroke rehabilitation.